Dr Mazen QusaibatyMD, DIS

Head Pulmonary and Internist Department Ibnalnafisse Hospital

Ministry of Syrian healthEmail: Qusaibaty@gmail.com

Lines & mediastinal Stripes - 01

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Topic Outline

1. Right Paratracheal Stripe2. Posterior wall of the bronchus intermedius3. Left Paratracheal Stripe4. Left subclavian artery border5. Posterior-superior junction line

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• Right paratracheal stripe

Chest radiograph with superimposed mediastinal stripes

Yellow• Right

paratracheal stripe

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The right paratracheal stripe (open arrows) is composed Of:

Right lateral tracheal wall

Small amount of mediastinal fat

Paratracheal lymph nodes

Visceral and parietal pleural layers of the

right upper lobe5

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Right paratracheal stripe

PA chest x ray widening of the right paratracheal stripe (arrow) Abnormal right paratracheal stripe caused by a large ectopic parathyroid adenoma in a 52-year-old man7

CT scan helps confirm a large right paratracheal mass (arrow)

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Guess the effect of this mass please !!

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A. AnemiaB. Dysphonia.C. Dysphasia.D. Primary hyperparathyroidism

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WHY ?Diffuse osteopenia from primary hyperparathyroidism.

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Quiz : long solid arrow is :

A. The right paratracheal stripe B. The pulmonary arteryC. Anterior junction line complexD. The pulmonary veinsE. The posterior wall of the bronchus intermedius

Quiz : long solid arrow is :

A. The right paratracheal stripe B. The pulmonary arteryC. Anterior junction line complexD. The pulmonary veinsE. The posterior wall of the bronchus intermedius

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Posterior wall of the Bronchus Intermedius

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Posterior Wall Of The Bronchus Intermedius

• Appears as a stripe

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Posterior Wall Of The Bronchus Intermedius

• Appears on lateral chest radiographs

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Posterior Wall Of The Bronchus Intermedius

• It is important in evaluating mediastinal disease

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Posterior Wall Of The Bronchus Intermedius

• The stripe representing the posterior wall of the bronchus intermedius

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The posterior wall of the bronchus intermedius is formed when

• Lung + Azygo-esophageal recess outlines this posterior wall

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Posterior Wall Of The Bronchus Intermedius

• Appears asA thinVertical or slightly

oblique stripe that typically projects

through the radiolucent area created by the left upper lobe bronchus

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Posterior Wall Of The Bronchus Intermedius

• This stripe is present on approximately 90%–95% of lateral chest radiographs

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Normal thickness Posterior Wall Of The Bronchus Intermedius

• Measures between 0.5 and 3.0 mm in thickness

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Abnormal thickening of the posterior wall of the bronchus intermedius

• Cardiogenic pulmonary edema

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Abnormal thickening of the posterior wall of the bronchus intermedius

Primary lung carcinoma Lymphadenopathy

Lymphoma

Metastatic disea

se

Tuberculo

sis

Sarcoidosis

SchnurMJ, Winkler B, Austin JH. Thickening of the posterior wall of the bronchus intermedius. Radiology1981; 139: 551–559.

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Left Paratracheal Stripe

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Left Paratracheal Stripe is formed by contact between

Left upper lobe

Mediastinal fat

Or left Tracheal wall

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Left Paratracheal Stripe

The stripe is extending superiorly from the

aortic arch

To join with the reflection from the left subclavian

artery superiorly

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Teaching Point / Left Paratracheal Stripe

• Visible on 21%–31% of PA chest radiographs

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Teaching Point / Left Paratracheal Stripe

• The left paratracheal stripe is seen less frequently than the right paratracheal stripe

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Teaching Point / Left Paratracheal Stripe

It may be obscured by contact between the left lung and either

• The proximal left common carotid artery anteriorly

• Or the left subclavian artery posteriorly

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Widening of Left Paratracheal Stripe

Neoplasm

Mediastinal hematoma

WoodringJH, Daniel TL. Mediastinal analysis emphasizing plain radiographs and computed tomograms. Med Radiogr Photogr1986; 62:1–48.

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PA Chest x Ray

Widening of the left paratracheal stripe (arrows)

with mass effect on the trachea

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Abnormal-appearing left paratracheal

stripe

A 47-year-old patient with metastatic thyroid carcinoma

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CT scan reveals a large thyroid mass (arrow)

Supraclavicular lymphadenopathy *

Chest radiograph with superimposed mediastinal stripes

Pink

• Left subcla

vian artery borde

r35

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Normal chest x ray

Left subclavian artery

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Left subclavian artery

• Aorta Angiogram

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Left subclavian artery / Angiogram

• Origin of subclavian

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Left subclavian artery / Angiogram

• Branches of subclavian artery

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Thoracic CT scan

Left subclavian artery

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Thoracic CT scan

Left subclavian artery

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Thoracic CT scan

Left subclavian artery

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Posterior-superior junction line

Chest radiograph with superimposed mediastinal stripes

Light green

•Posterior-

superior

junction line

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PA chest X ray shows the posterior junction line (arrow)

Projecting through the tracheal air column

PA chest X ray shows the posterior junction line (arrow)

Note that the line extends above the level of the clavicles.

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CT scan shows the posterior junction line

• which is formed by:The interface

between the lungs posterior to the mediastinum

Consists of four pleural layers

Anterior and Posterior Junction Lines

• Anterior junction line (retrosternal space)• Posterior Junction lines (retrotracheal space)

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PA chest X ray shows a mass (arrow)

obliterating the posterior junction lineNote that the mass extends above the level of the clavicle

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PA chest X ray shows a mass (arrow)

obliterating the posterior junction line

• The mass has a well-demarcated outline due to the interface with adjacent lung (arrowhead)

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Can you guess the diagnosis ?

A. Bronchogenic cystB. LymphomaC. ThymomaD. TeratomaE. Thyroid enlargement

Can you guess the diagnosis ?

A. Bronchogenic cystB. LymphomaC. ThymomaD. TeratomaE. Thyroid enlargement

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